Healthcare Provider Details

I. General information

NPI: 1154239820
Provider Name (Legal Business Name): KELLY COLLEEN PARKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N SENATE AVE
INDIANAPOLIS IN
46202-5306
US

IV. Provider business mailing address

8021 SPRINGWATER CIR
INDIANAPOLIS IN
46256-1685
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-2000
  • Fax:
Mailing address:
  • Phone: 317-590-3125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28128839A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: